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Digital Overuse: Is Your Screen Time Affecting Your Health?

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Screens are a part of everyday life. Whether we’re working on a computer, scrolling through our phones, attending virtual meetings, or relaxing with a favorite show, digital devices help us stay connected and productive. However, spending too much time on these devices can have unintended effects on our physical health.

Known as digital overuse, this growing concern can lead to discomfort, pain, and decreased mobility if left unaddressed.

What Is Digital Overuse?

Digital overuse occurs when prolonged screen time and repetitive device use lead to physical strain on the body. Hours spent sitting, looking down at devices, or performing repetitive movements like typing and texting can contribute to poor posture and musculoskeletal issues.

Common symptoms include:

  • Neck and shoulder pain (“tech neck”)
  • Back pain and poor posture
  • Wrist and hand discomfort
  • Headaches and eye strain
  • Reduced flexibility and overall movement

Over time, these issues can interfere with daily activities and overall well-being.

How Physical Therapy Can Help

Physical therapy offers an effective way to address both the symptoms and underlying causes of digital overuse. Rather than simply managing pain, physical therapists focus on improving movement, strengthening weak areas, and preventing future injuries.

Some of the ways physical therapy can help include:

Posture Improvement

A physical therapist can identify postural imbalances and provide strategies to improve alignment while working, sitting, and using digital devices.

Targeted Exercises

Personalized stretching and strengthening programs can help relieve tension in the neck, shoulders, and back while improving mobility and core stability.

Pain Relief

Hands-on treatment techniques, therapeutic exercises, and other non-invasive interventions can help reduce pain and restore function.

Ergonomic Guidance

Simple adjustments to desk setup, screen height, and workstation positioning can significantly reduce strain during daily activities.

Movement Strategies

Learning to take regular movement breaks and incorporate stretching throughout the day can help combat the effects of prolonged sitting.

Simple Steps You Can Take Today

Reducing the effects of digital overuse doesn’t have to be complicated. Try these simple tips:

  • Follow the 20-20-20 Rule: Every 20 minutes, look 20 feet away for 20 seconds.
  • Keep screens at eye level whenever possible.
  • Sit with your feet flat on the floor and your back supported.
  • Stretch your neck, shoulders, and upper back throughout the day.
  • Take movement breaks every 30–60 minutes.

When to Seek Help

If you’re experiencing persistent neck, back, or shoulder pain, tingling in your hands or arms, frequent headaches, or difficulty maintaining good posture, it may be time to consult a physical therapist. Early intervention can prevent minor aches from becoming long-term problems.

Stay Connected—Without the Pain

Technology isn’t going anywhere, and it shouldn’t have to. By building healthier habits, improving posture, and staying active throughout the day, you can enjoy the benefits of digital devices without sacrificing your physical health.

Taking care of your body today can help prevent discomfort tomorrow—and physical therapy can help you stay moving, healthy, and connected.

 

If Payors Shift Routine MSK Away From Hospitals, What’s Left? 

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For hospital rehabilitation leaders, the shift of routine musculoskeletal (MSK) care to lower-cost settings can feel like a direct threat. As payors increasingly direct straightforward orthopedic and MSK cases toward retail outpatient clinics many hospital-based programs are asking the same question: 

What’s left for us? 

The answer is not to cede ground — it’s to compete smarter. 

Hospital rehabilitation programs that thrive in this environment will do two things well: continue to compete for routine MSK volume using outcomes, clinical quality, and specialized certifications, while simultaneously building the specialty services that lower-cost competitors simply cannot match. These are not competing strategies. They are complementary ones. 

 

Why Payors Are Directing Care Elsewhere 

Payors have a clear financial incentive to direct care to lower-cost settings. In many cases, this is as much about improving their own margins as it is about managing costs on behalf of employer-sponsored health plans. When a straightforward knee replacement recovery or uncomplicated low back pain episode can be treated safely outside a hospital, payors will continue to direct those patients away from hospital-based services. 

This trend is unlikely to reverse. 

But the response shouldn’t be retreat. Hospitals have real advantages in routine MSK care — clinical outcomes, staff credentials, specialized certifications, care coordination infrastructure — and those advantages are worth competing on. The goal is not to abandon routine care. It’s to ensure that routine care is not all you offer. 

 

The Case for Specialty Services as a Differentiator 

Specialty rehabilitation services matter not as a fallback when routine volume disappears, but as a strategic layer that strengthens the overall program. They deepen physician relationships, expand the patient population a program can serve, and create a level of clinical value that independent and community providers are poorly positioned to replicate. 

Profitability in specialty populations is genuinely challenging. Neuro, oncology, and complex orthopedic patients require more time, more coordination, and more clinical resources than routine MSK cases. That’s precisely why these services work best as part of a balanced program. 

Hospitals that build specialty services alongside a healthy routine volume base are better positioned to sustain them. 

Neuro Rehabilitation: A Growing Opportunity 

Patients recovering from stroke, traumatic brain injury, spinal cord injury, Parkinson’s disease, multiple sclerosis, and other neurological conditions require far more than routine therapy visits. Successful neuro rehabilitation demands close physician collaboration, advanced clinical specialization, multiple therapy disciplines, complex care coordination, and longitudinal patient management. 

These programs depend on integrated teams — physical therapists, occupational therapists, speech-language pathologists, physiatrists, neurologists, nurses, social workers, and case managers working in concert. That level of coordination is difficult to duplicate in fragmented care settings. 

As healthcare becomes more specialized, comprehensive neuro rehabilitation may become one of the strongest differentiators for hospital-based programs because it signals a depth of capability that routine providers cannot claim. 

 

Oncology Rehabilitation Is Becoming Essential 

Cancer survivorship continues to grow, creating increasing demand for rehabilitation services before, during, and after treatment. Patients frequently experience cancer-related fatigue, neuropathy, lymphedema, functional decline, balance deficits, cognitive changes, and complex comorbidities — often simultaneously. 

Effective oncology rehabilitation requires close alignment with oncology teams and individualized treatment plans that evolve alongside medical care. Hospitals are uniquely positioned to integrate rehabilitation into the broader cancer care continuum, making oncology rehab an area where specialized expertise creates significant value for patients, providers, and payors alike. 

 

Complex Orthopedic Programs Remain a Hospital Strength 

Not all orthopedic rehabilitation is routine and hospitals shouldn’t treat it as though it is. 

Revision surgeries, trauma cases, multiple-joint involvement, post-operative complications, medically fragile patients, and individuals with significant comorbidities require a higher level of clinical oversight and coordination. These patients benefit from specialized orthopedic pathways, collaborative physician management, advanced outcome tracking, and clear escalation pathways when complications arise. 

As payors direct more routine orthopedic cases elsewhere, hospitals have an opportunity to become recognized centers of excellence for the cases that require deeper expertise. That positioning reinforces rather than replaces their value to the orthopedic service line. 

 

Multidisciplinary Care Is Difficult to Replace 

One of the most underappreciated advantages of hospital rehabilitation programs is their ability to bring multiple specialists together around a single patient. Complex patients rarely fit neatly into one diagnosis. A patient recovering from stroke may also have cardiac disease. A cancer survivor may have orthopedic limitations. An older adult recovering from surgery may face neurological, cognitive, and social barriers simultaneously. 

Hospital-based programs can coordinate care across disciplines in ways that independent providers often cannot — and that integrated approach creates a level of clinical value that is difficult for competitors to replicate, regardless of their cost structure. 

 

Specialty Populations Create Sustainable Differentiation 

The most resilient rehabilitation programs are often built around patient populations with unique needs: pediatric rehabilitation, vestibular disorders, pelvic health, movement disorders, limb loss and amputee care, spinal cord injury, chronic pain programs, and adaptive sports and performance programs. 

These services require specialized expertise, dedicated staff training, and clinical infrastructure that takes years to develop. As a result, they are less vulnerable to site-of-care shifts and reimbursement pressures — and they give referring physicians a reason to think of your program first across a broader range of patients. 

 

What This Looks Like in Practice 

These aren’t hypothetical strategies — they’re outcomes from rehabilitation programs we partner with through our Hospital Solutions model. 

In one community market, we helped grow a hospital-based outpatient clinic by recruiting physical therapists and PTAs who had earned the trust of local physicians and established strong referral relationships within the healthcare community. Rather than starting from scratch to build a referral network, we leveraged those existing relationships, allowing the program to grow more quickly. 

In another partner program, we worked with the hospital’s orthopedic service line to develop a formal Total Joint Program — standardized pre-operative education, streamlined scheduling, and structured communication between therapy and surgical teams. What had been an informal referral relationship became an integrated care pathway that strengthened routine orthopedic volume while positioning the program as the obvious choice for more complex cases. 

That same program identified an untapped opportunity in women’s health. By establishing standardized referral protocols with OB/GYN physicians — including clear indications for referring new mothers from the maternity ward — pelvic health services went from ad hoc to consistent and growing. 

We’ve also supported partner programs in building out occupational therapy upper extremity and hand specialty services across multiple clinic locations. These aren’t add-ons — they’re purpose-built service lines that referring orthopedic and sports medicine physicians increasingly depend on, and that community competitors are poorly positioned to replicate. 

The throughline across all of it: growth came from competing deliberately for routine volume while building the specialty depth that makes a program genuinely hard to replace. 

 

The Strategic Question Has Two Parts 

Hospital leaders shouldn’t just ask which patients are moving elsewhere. They should ask two questions in parallel: 

How do we continue to compete for the routine cases that sustain our program? 

Which patients are uniquely dependent on capabilities that only we can provide? 

The answers to both questions point toward the same destination — a rehabilitation program that is clinically credible across the full spectrum of patient need, financially sustainable because it isn’t dependent on any single patient population, and strategically differentiated in ways that are genuinely hard to replicate. 

 

The Bottom Line 

Payors directing routine MSK care away from hospitals does not signal the end of hospital-based rehabilitation. It signals the need for a more deliberate strategy. 

The programs most likely to thrive will be those that do both: compete hard for routine MSK cases on the strength of their outcomes and clinical quality, while building specialty services that deepen their value to physicians, patients, and health systems. 

Hospital Solutions

How Hospital Outpatient Rehab Programs Win by Operating Like a Business

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Most hospitals treat outpatient rehab like a department. They staff it, schedule it, and hope the referrals keep coming — measuring performance by headcount and complaints, not margin and market share. The hospitals winning right now treat it like a business.

Why the “department” mindset no longer works for outpatient rehab

For a long time, passive management worked. Internal referrals were predictable, reimbursement was stable, and competition was limited. That environment no longer exists.

Today, outpatient rehab is consumer driven. Patients choose based on access, convenience, and experience — not hospital brand loyalty. Major payors like Cigna and Anthem are actively redirecting routine musculoskeletal (MSK) care to lower-cost sites of care. Freestanding clinics are investing in marketing, building referral relationships, and capturing patients earlier. Meanwhile, hospital rehab margins are compressed from both sides — reimbursement flat or declining, labor costs rising. There is no slack left for operational inefficiency.

5 shifts that define a high-performing outpatient rehab program

Running an outpatient rehab program like a business is not about profit for its own sake. It is about the discipline, intentionality, and market awareness that any successful ambulatory business requires to grow and sustain itself.

1.Know your numbers — and act on them in real time

A business does not wait for the annual review to find out it had a bad quarter. It tracks key metrics continuously and builds accountability structures that drive action when performance moves in the wrong direction.

Most hospital outpatient rehab programs lack this infrastructure. Performance data lives in the EMR, gets pulled quarterly at best, and rarely drives meaningful operational changes. The gap between knowing and acting is where margin quietly erodes.

2.Compete actively for patients and referrals

A business does not assume customers will find it. It invests in being found through targeted marketing, active referral relationship development, and a consistent presence with the physicians and community partners who drive volume.

Passive reliance on internal referrals is no longer a growth strategy for outpatient rehab. It is a slow decline. The freestanding clinic down the street calls your referring physicians weekly. It has a dedicated person whose job is to make those relationships stronger. It is building trust through consistent outreach, outcome transparency, and ease of access.

Hospital-based programs that do not invest in proactive referral development and community presence will continue to lose volume to more aggressive competitors — regardless of clinical quality.

3.Treat patient access as a core growth strategy

In competitive outpatient rehab markets, wait time is often the deciding factor for both patients and referring physicians. Patients who cannot be seen within a few days will find a provider who can. Referral sources that receive consistent feedback about long wait times will begin routing patients elsewhere.

High-performing outpatient rehab programs treat access as a strategic lever, not an operational detail. They optimize scheduling models, reduce throughput bottlenecks, and protect their ability to provide timely evaluations because they understand that every additional day of wait time is a patient conversion risk and a referral retention risk.

4.Retain patients through the full plan of care

Acquiring a new patient is only the beginning. Retaining them through a complete plan of care is where both outcomes and revenue are captured.

High cancellation and drop-off rates are one of the most significant and most under addressed drains on outpatient rehab financial performance. Patients who do not complete their plan of care do not achieve the outcomes they came for, do not refer others, and represent a direct revenue loss that compounds across high visit volumes.

Leading programs invest in patient engagement infrastructure: automated appointment reminders, digital touchpoints between visits, and patient education that builds understanding of why each session matters. They also align front office teams and clinicians around shared accountability for retention — not just first appointments, but final ones.

5.Develop rehab directors who manage a business, not just a team

Perhaps the most consequential shift is in how rehab directors understand their own role.

The best outpatient rehab leaders today are not just clinical experts. They are operators. They own the financial performance of their program. They manage referral relationships intentionally. They partner with hospital service line leaders — orthopedics, neurology, oncology — to design care pathways that create value for the whole organization. They recruit and develop talent with the same intentionality a business leader brings to building a high-performing team.

This is a harder job than managing a department. It requires a broader skill set, a wider field of vision, and a willingness to be accountable for outcomes that extend well beyond clinical quality. But it is the role the current market requires of anyone leading a hospital outpatient rehab program.

The competitive gap between programs is widening

The distance between outpatient rehab programs that operate like businesses and those that do not is growing and it is becoming increasingly difficult to close.

Programs investing in real-time data, operational discipline, proactive referral development, patient engagement, and strong leadership are building compounding advantages: stronger physician relationships, faster access, higher retention, more differentiated clinical offerings, and better margins. Programs that are not investing in these areas are losing volume, losing talent, and losing relevance — often slowly enough that leadership does not notice until the damage is significant.

The question for hospital executives and rehab leaders is not whether outpatient rehab should be run like a business. The market has already answered that question.

The question is whether your program is ready to make the shift and whether you are willing to invest in the capabilities it requires before the competitive gap becomes too wide to close.

 

Stroke Support Month – The Power of Rehabilitation Through Every Stage of Recovery

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Stroke Support Month – The Power of Rehabilitation Through Every Stage of Recovery

Each May, Stroke Support Month shines a light on the millions of individuals and families impacted by stroke—and the journey of recovery that follows. A stroke can change life in an instant, affecting movement, communication, thinking, and independence. While every stroke is different, one thing remains consistent: rehabilitation therapy plays a vital role in helping people rebuild their lives.

Recovery is not a single moment—it is a journey that unfolds over time. From the earliest days in the hospital to long-term outpatient care, physical therapy, occupational therapy, and speech therapy work together to support recovery, maximize function, and restore confidence.

 Understanding Stroke Recovery

A stroke occurs when blood flow to the brain is interrupted, causing damage that can affect the body in many ways. Individuals may experience:

  • Weakness or paralysis
  • Difficulty walking or balancing
  • Trouble speaking or understanding language
  • Challenges with daily tasks
  • Memory, attention, or problem-solving difficulties
  • Swallowing or voice changes

Recovery looks different for everyone, but therapy is most effective when it begins early and continues as long as progress is possible.

 Therapy in the Hospital: Beginning the Recovery Journey

Rehabilitation often begins within days of a stroke while a patient is still in the hospital. This early phase focuses on stability, safety, and preventing complications.

Therapists may help individuals:

  • Sit up and begin moving safely
  • Stand, transfer, or take early steps
  • Swallow safely to reduce risk
  • Start basic communication

These first steps are critical in setting the foundation for ongoing recovery and regaining independence.

 Therapy at Home: Building Independence

After discharge, many patients continue therapy through home health services. Receiving care in a familiar environment provides comfort while allowing therapy to focus on real-life tasks.

In-home therapy helps individuals:

  • Regain strength and balance
  • Practice walking, dressing, bathing, and other daily activities
  • Improve speech, thinking, and swallowing skills
  • Reduce fall risk and increase confidence

This stage supports the transition from hospital to everyday life, helping patients rebuild independence safely.

 Outpatient Therapy: Maximizing Long-Term Recovery

As strength and endurance improve, many individuals move on to outpatient therapy. This phase focuses on higher-level goals and long-term function.

Outpatient therapy may include:

  • Improving walking speed, distance, and endurance
  • Refining arm and hand function
  • Enhancing communication and cognitive skills
  • Supporting return to work, hobbies, and community activities

Recovery can continue for months—or even years—with consistent therapy and support.

 The Power of Rehabilitation: A Team Approach

Stroke recovery is most successful when therapies work together. Each discipline plays a unique and essential role:

 Physical Therapy: Rebuilding Strength and Mobility

Physical therapists help individuals regain movement, balance, and coordination. Therapy may focus on:

  • Improving strength and endurance
  • Restoring safe walking and mobility
  • Reducing fall risk
  • Managing pain, stiffness, or muscle tone changes

 Occupational Therapy: Restoring Daily Independence

Occupational therapists focus on meaningful daily activities and independence. They help with:

  • Dressing, bathing, grooming, and eating
  • Using the affected arm or hand
  • Cognitive skills like planning and problem-solving
  • Adaptive tools and home modifications
  • Returning to work and hobbies

 Speech Therapy: Supporting Communication and Swallowing

Speech-language pathologists address communication, cognition, and swallowing. Therapy may include:

  • Improving speech clarity and language skills
  • Addressing memory and attention challenges
  • Supporting voice strength
  • Treating swallowing difficulties

Together, these therapies address the whole person—body, mind, and communication—ensuring comprehensive and coordinated care.

 Recovery Doesn’t Stop—And Neither Does Support

Progress after a stroke doesn’t end at discharge. Many individuals continue to make meaningful gains long after the initial event. Rehabilitation empowers survivors to:

  • Regain skills
  • Adapt to changes
  • Build confidence and independence
  • Reconnect with loved ones
  • Reclaim their sense of self

Every step forward—no matter how small—is significant.

 Honoring Strength During Stroke Support Month

This Stroke Support Month, we celebrate the resilience of stroke survivors, the dedication of caregivers, and the expertise of rehabilitation professionals who guide recovery every step of the way.

Whether recovery begins in the hospital, continues at home, or progresses through outpatient care, therapy plays a powerful role in helping individuals move forward with strength, confidence, and hope.

If you or a loved one has experienced a stroke, rehabilitation therapy can make a difference—at any stage of the journey.

The Importance of Rehabilitation in the Cancer Journey

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Cancer arrives like a sudden storm, altering the landscape of life in an instant. It does not come quietly. It disrupts, demands, and leaves no one untouched. Yet even in its wake, there is a path forward. Rehabilitation is the bridge between what was and what can be, guiding patients toward renewed strength, movement, and hope.

At Tx:Team, we have felt the weight of this journey in a deeply personal way. Two of our own leaders have walked this path and their experiences serve as a reminder that the impact of this disease extends far beyond the individual. It reaches families, friends, and entire communities. Their resilience deepens our commitment to compassionate, comprehensive care.

Everyone remembers the day they were told, “You have cancer.” Once those words are spoken, life changes in an instant. Cancer patients undergo a variety of treatments, including surgery, radiation, and chemotherapy. While these treatments all share the same goal of achieving remission, they also come with significant side effects. Some of these effects are temporary, while others linger even after the celebratory ringing of the bell. As one survivor shared, “No one really tells you about the long-lasting side effects. You are so focused on the immediate treatment plan and fighting this disease that you really don’t think about what comes after.”

The side effects of cancer treatments—fatigue, loss of strength, mobility challenges, cognitive difficulties, and issues with speech or swallowing—can persist long after treatment ends. This is where physical, occupational, and speech therapists collaborate as a unified team. Each therapist brings their expertise to create a personalized, holistic rehabilitation plan, nurturing the body, mind, and spirit. Together, they offer a comprehensive approach to recovery, helping patients reclaim their strength, independence, and quality of life.

In the face of cancer’s challenges, rehabilitation offers a vital path to recovery. It is a journey of resilience, supported by skilled professionals who understand the full scope of healing. At Tx:Team, we are honored to be part of that journey, walking alongside cancer survivors as they reclaim their strength and embrace the future with hope.

The Value of Physical Therapy in Osteoarthritis of the Knee

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Osteoarthritis of the knee is the most common type of osteoarthritis, or OA, in the United States. According to the American Physical Therapy Association (APTA), nearly 12.4 million Americans ages 65 or older suffer from symptoms of knee OA, including morning stiffness, pain during or after activity, discomfort after sitting, knee popping or grinding, swelling, and joint tenderness.

Physical therapy is a proven, effective treatment for knee OA. The goal of treatment is to reduce pain, get you moving again, and help you enjoy life’s little pleasures — whether that’s a walk in the park or dancing at a family gathering.

The APTA’s 2023 report highlighted the cost-effectiveness of treating knee osteoarthritis with physical therapy. They used quality-adjusted life years (QALYs) to measure both how long someone lives and their quality of life, making it easier to compare treatments like reducing pain or improving mobility. On average, physical therapy for knee osteoarthritis provides a net benefit of nearly $14,000 per episode of care, including all the hidden costs of your time, pain, missed life events, and the dollars paid for services. Compared to steroid injections, patients who received physical therapy had a 0.07 higher QALY, with only a slight increase in medical costs.

Physical therapy offers patients valuable benefits, including knowledge to help reduce the risk of opioid addiction and cost savings by avoiding invasive steroid injections and surgeries. Additionally, it provides long-term advantages such as improved mobility, balance, strength, and flexibility. These enhancements contribute to better overall health and a lower risk of developing conditions that may require additional healthcare services in the future.

Your physical therapist can refer you to an orthopedic surgeon to discuss your options for dealing with knee OA. If you choose surgery after consulting with healthcare professionals, physical therapy plays a crucial role in both preparation and recovery, as noted by the APTA. Pre-surgery physical therapy (“prehab”) helps improve strength and flexibility, setting you up for a smoother recovery. After surgery, your physical therapist will create a personalized program based on your condition and goals to help restore function and mobility.

If you’re dealing with knee OA, give physical therapy a try. It’s an investment in getting back to the things you love without pain.

You Take that First Step and OUCH

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You get out of bed and go to take that first step. OUCH! 

A sharp pain hits your foot. You limp a few steps but before you are out the door, the pain is gone. After sitting at work for a couple hours, you get up for another cup of coffee and the pain returns. 

It’s possible you are dealing with plantar fasciitis.

But what exactly is plantar fasciitis and what can we do about it? 

The suffix -itis indicates inflammation. Plantar fasciitis is inflammation of the plantar fascia. This leads to the next question, what is the plantar fascia? Plantar is the bottom side of the foot and fascia is a thin casing of connective tissue. Putting those two together, the plantar fascia is a band of connective tissue that runs from your heel to your toes, and it helps support the arch of your foot, stability of the foot, and is involved with normalized foot mechanics. Unfortunately, through a series of microtears from overstress and over stretch, the fascia can get inflamed and plantar fasciitis occurs.

Why exactly does plantar fasciitis occur is a great question. There are a few common risk factors to look at first. Generally, it will occur in people 40-70 years old. Activities such as running and dancing can increase the risk of developing plantar fasciitis. Occupations that keep you on your feet also increase the risk for developing it. People who are overweight or obese place more stress on their feet and this can cause plantar fasciitis. Lastly, if you have abnormal foot posture or walking pattern, e.g. flat feet, high arches, this can increase risk as well.

Now what to do about it? 

  • It is important to keep your calves loose. When the calf muscles become tight, they will pull up on the achilles, which pulls up on the heel, which stresses the plantar fascia.
  • Improving the strength of the arches of the feet can also reduce stress placed on the plantar fascia.
  • Stretching your big toe backward (toward the top of your foot) can provide an excellent stretch on the plantar fascia and rolling your foot on a lacrosse ball is another great option.
  • Orthotics can also help to normalize your foot if you have high arches or flat feet, thus reducing the stress on the plantar fascia.

Although plantar fasciitis can be a painful way to start the day, it is certainly treatable through a variety of stretches, exercises, and lifestyle modifications. If you feel you are suffering from plantar fasciitis, make an appointment with your local Physical Therapist and get back on your feet and  walking pain free.

Alex Strahle, PT, DPT, CSCS graduated from the University of Evansville with a Bachelor of Science in Exercise Science and a Doctor of Physical Therapy.  He is currently a Physical Therapist in the Employer-Based Clinic setting for Tx:Team.  Alex enjoys seeing patients return to an active lifestyle after treatment for their pain and dysfunction.

April is Parkinson’s Awareness Month – #Take6forPD

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According to the Parkinson’s Foundation, every six minutes someone is diagnosed with Parkinson’s Disease in the United States.

April is Parkinson’s Disease (PD) Awareness Month and along with the PD Community, we are encouraging everyone to take six minutes in an effort to raise awareness, advance the research, and become knowledgeable of the available treatments for this disease. With someone being diagnosed every six minutes, that totals 90,00 people per year in the United States alone.  Let’s be advocates.

Beyond awareness comes treatment. At Tx:Team, we have Physical, Occupational, and Speech Therapists who are trained and certified in treating patients with PD. One treatment program which has been proven beneficial is the LSVT BIG® and LOUD® Program.

How do the LSVT programs benefit Parkinson’s patients?

Parkinson’s can impact function in everything a person does at home, at work, and in their community recreational pursuits. The LSVT programs help patients to maintain movement and voice for normal function in everyday life beyond medication and repetitive, non-direct task training exercises utilizing principles of neuroplasticity backed by years of research. It takes all 16 visits (four times per week for four weeks) to achieve carry over so that by the end of one month, patients know how to move BIGGER and be LOUDER all the time.   

A unique feature of LSVT BIG® and LOUD® is that it recognizes there is an internal cuing proprioceptive issue in individuals with Parkinson’s such as softer voice and smaller movements, in people that are unable to recognize their deficits the majority of the time.   

What is the focus of LSVT BIG®?

  • Faster speed  
  • Greater arm swing   
  • Longer steps  
  • Overcoming difficulty getting through the doorway  
  • Longer distance  
  • Faster clothing donning  
  • Grasping materials during meal preparation  
  • Legible handwriting  
  • Amplitude of movement when showering  

What is the focus of LSVT LOUD®?

  • Louder voice that is not hoarse  
  • Improved facial expression   
  • Reduction of monotone speech  
  • Improved emotion  
  • Using more words  

Who would benefit from BIG® and LOUD®?  

Patients who have a decline in the amplitude of their movement, voice, posture, and balance in addition to reduced speech intelligibility are motivated to participate in all required sessions.  

Why are these programs so important to this patient population?  

LSVT BIG® and LOUD® assists this patient population in maintaining, enhancing, and slowing progression of Parkinson’s Disease, which in return facilitates their ability to maintain a level of independence with the following skill sets essential for daily living:   

  • Changes in cognitive function. People with PD can still learn, but it might take longer and require more repetition of practice. As a patient progresses, the therapist will work on dual tasking so you can keep moving bigger and being louder while doing something else at the same time. For example, getting dressed and talking, walking while carrying something, or tapping your leg while reading.
  • Changes in movement amplitude. Commonly, people with PD have difficulty with activities they didn’t before. As a patient progresses, utilizing larger movements helps patients return to these activities without cues and assistance. 
  • Changes in communication. People who have PD have soft speech and feel that they are talking WNL while others “need a hearing aid.” However, people may begin to feel embarrassed with social isolation. As a patient progresses with continuous use of a loud voice, they are able to participate in conversations without feeling excluded while maintaining their dignity.
  • Changes in emotional regulation, pacing, attention, cardiovascular health, sleep, and confidence can also be seen!  

If you have any more questions about the LSVT program for BIG® or LOUD®, find a certified therapist in your area or visit this website.

 

Nidhi, Alita, and Johanna are all experienced therapists in the Outpatient Clinic setting in Frederick, MD.  They work collaboratively together to support and treat patients with a variety of neurological diagnoses. Nidhi, Alita, and Johanna enjoy the relationships they foster with their patients, and they love to help them achieve their functional goals.

Nidhi Talpade, PT, DPT, BIG® Certified
Alita Borkar, MA, OTRL, BIG® Certified
Johanna Ebbs, MS, CCC-SLP, LOUD® Certified.

Female Athletes and ACL Prevalence

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As a former female division 1 gymnast, I personally experienced and witnessed many types of injuries. I had a few teammates who had recurring injuries that impacted their ability to continue the sport they loved. Seeing the sub-par rehabilitation process in a college setting without physical therapy interventions available, re-injury was extremely common. Many of these recurring injuries involved the knee and internal knee structures such as the ACL, PCL, MCL, and LCL. 

ACL injuries are becoming more and more common in the young athlete, but did you know that female athletes are up to 10 times more likely to experience an ACL injury compared to men? This may be due to the anatomy and biomechanics of the female knee joint. Often due to wider hips and a smaller groove at the bottom of the femur where the ACL inserts, the ACL in the female knee may experience greater stress and further restriction during twisting, jumping, changing direction, and landing movements compared to men. Other contributors to increased risk of injury include weakness of the posterior chain musculature (glutes and hamstrings) and ligament laxity during hormone cycles. Recent studies have found that woman may be more susceptible to ACL injury just prior to ovulation compared to the follicular phase due to increased ligament laxity.

The most common form of treatment following ACL injury is a reconstructive surgery using a graft from either the patient’s own patellar tendon, hamstring, or an ACL from a cadaver. Although an athlete may go through ACL reconstruction, it does not guarantee normal functions of the knee or prevention of subsequent knee injury. In recent studies, it has shown that about half of athletes who underwent ACL reconstruction return to high level sports, and only about 20% of these younger athletes will return to higher level sports in the first year following injury. Given these findings, it is extremely important that ACL rehabilitation encompasses deficits related to surgical interventions as well as initial cause of injury occurring prior to surgery.

Current generalized ACL rehabilitations programs may not have all-inclusive motor training, and neuromuscular re-education needed to safely allow return to sport within one year’s time. It has been statistically proven that proper recruitment and strength of the posterior chain as well as muscles that stabilize the knee will decrease risk of  re-injury in the young athlete with a prior ACL tear. Physical therapists have the training and knowledge to specifically pinpoint weakness and instability within the hip and knee complex, analyze gait and movements patterns, and build sport specific training programs to assist in injury prevention of the young athlete. 

In early rehabilitation, it is crucial to protect the graft site, and begin regenerating the quad musculature. Research shows that following knee injury or surgical interventions there is a reflex response to inhibit muscle activation called Arthrogenic Muscle inhibition (AMI). Physical therapy can assist in targeting the muscles that have been affected during this reflex inhibition process. Some examples include quad setting, resisted terminal knee extension, straight leg raises with a knee extension brace until the patient can complete a straight leg raise without knee flexion. Other exercises to assist overall hip and knee stability include closed chain activity such as partial squats, step ups, single leg balance activities, and bridges. It is critical for the physical therapist to ensure the patient is completing exercises without compensatory strategies and progressing toward proper movement patterns. 

Due to the high prevalence of re-injury, as well as muscular inhibition following knee injury, it is highly recommended that athletes, specifically women receive intensive rehabilitative care following ACL repair. Without specific neuromuscular re-education, proper movement pattern restoration, and addressing pre-injury mechanical deficits, young athletes are at risk for re-injury or significant time lapses as they attempt to return to sport. Physical therapy can provide young athletes with the education and tools they need for success as they return to the sports they love. 

Amanda Lievendag, DPT, CMTPT is a Physical Therapist in the outpatient setting at Frederick Health Physical Therapy & Sports Rehab. Amanda’s professional interests are Sports Orthopedics, Sports Rehab, Trigger Point Dry Needling, and Spine Rehabilitation. She is a high energy physical therapist who has specialized experience with post-op, sports injuries, return-to-sport training, overuse injuries, and general wellness with athletes and patients of all ages.

 

The Importance of Rehab When Recovering from Covid-19

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Patients recovering from Covid-19 experience a variety of negative side effects, both cognitive and physical, and without rehabilitation, those side effects can continue for much longer if not permanently.

In a study published by The Lancet, 76% of Covid-19 patients reported that they were still experiencing at least one symptom associated with the Covid-19 six months after they were discharged from the hospital, including 63% who reported experiencing fatigue or muscle weakness at the time of the evaluations. According to the researchers, fatigue and muscle weakness were the most-reported symptoms among the participants at the six-month follow-up evaluations.

Fatigue and muscle weakness are two main physical symptoms that patients experience during and after being diagnosed with Covid-19. After only three days in the ICU, a patient may lose up to 9% of muscle mass, while some reports indicate brain scans resemble that of a traumatic brain injury. That’s where the role of rehabilitation comes in.

“It’s important not to wait (to start rehab) – the longer you experience muscle atrophy, it becomes a vicious cycle,” said Rich Stieglitz, Director of the Department of Rehabilitation at Tx:Team in Frederick, MD. “If you’ve become deconditioned and weak, you could start to experience back pain and joint pain; you’re at risk to hurt yourself if you’re not strong enough. When you don’t feel good, you don’t move. When you don’t move, you don’t feel good. It’s important to get your body systems going, being able to move and move correctly.”

Rehab in the Hospital After a Covid-19 Diagnosis

After being diagnosed with Covid-19 during the acute phase, it’s important to start exercises in small doses. “The more exercises they can tolerate in short stints, the better their lung capacity can be,” said Stieglitz. “We work with patients all the way from being on ventilators to getting out of bed to walking. When you’re hospitalized due to Covid-19, your strength and endurance is compromised, you need assistance. And because of the addition of Covid fog, you lose the ability to think and connect all the dots. If a patient doesn’t have any strength and they’re gasping for air, it’s hard to tell them to turn over in bed – we have to show them. Simply sitting up and not falling over is a challenge. We’re trying to protect patients.”

Outpatient Rehab for Recovery 

After leaving the hospital, it’s important to address everything from fatigue to depression in Covid patients. While we have the ability to do rehab in-person, patients can also choose to do their rehab through telehealth in the comfort of their own home during the quarantine phase for early intervention. Through telerehab, we can work on strength, endurance, cognitive, and respiratory functions with patients through physical, occupational, and speech therapy.

Covid-19 Rehabilitation

When it comes to rehabilitating a patient during or after Covid-19, there are a variety of exercises available. “Depending on the patient’s ability, we’re going to focus on generalized strength training and endurance,” said Stieglitz. “It might be a challenge to walk to the mailbox for a patient, maybe you can’t carry in your groceries. We’ll assess a patient from a functional standpoint and then work to simulate tasks that you used to be able to do but can’t do now.”

Covid rehab starts with breaking down the activity or exercise to its sub-components to strengthen the pieces a patient is struggling with and increase their function. For example, if a patient is getting winded walking a flight of stairs, a therapist can work with them to walk on a treadmill or walk against water currents in a pool.

“There are lots of techniques to try to make it fun and encouraging,” said Stieglitz. “We want to set them up for success and engage the patients so they can see their progress. It’s all designed at returning to what they were doing before they got sick so they can return to their job or recreational activities. Let’s get motion back into your life while we monitor your blood oxygen levels, blood pressure, and vital signs to make sure you’re okay and won’t crash. Covid knocks you down and we want to make sure patients are safe.”